Autologous retinal transplantation yields good outcomes for macular holes

In this retrospective study, investigators report the anatomic and functional outcomes of autologous retinal transplantation (ART).

Study design

Thirty-three vitreoretinal surgeons worldwide performed 130 ART surgeries for repair of primary and refractory macular holes, and macular holes combined with rhegmatogenous retinal detachment (RRD). OCT images were graded by 2 masked reviewers. The main outcome measures included macular hole closure rate, visual acuity, external limiting membrane (ELM) and ellipsoid zone (EZ) band integrity and alignment of neurosensory layers on OCT.

Outcomes

Overall, 27% of surgeries were performed for macular hole repair, 58% for refractory macular holes and 15% for macular holes combined with RRD. After a mean follow-up of 8.6 months, visual acuity improved from 1.37 to 1.05 logMAR. Surgery closed 89% of macular holes and 95% of macular holes with RRD. After the procedure, 43% of eyes gained 3 or more lines in visual acuity, with 29% of eyes gaining 5 or more lines. Better visual acuity was tied to reconstitution of the ellipsoid zone and alignment of neurosensory layer on OCT. Complications were rare: the study found 3 cases of intraoperative graft slippage, 2 cases with undersized grafts, 1 case with subfoveal retinal pigment epithelium (RPE) damage and 4 cases of intraocular bleeding.

Limitations

This was a retrospective study with ancillary tests available for some cases but not all. The study did not present data on chronicity of macular hole duration and lacked a control group.

Clinical significance

This international study demonstrated that ART for macular holes with or without RRD can yield good anatomic and functional outcomes with low rates of complications.